Provider Demographics
NPI:1417565714
Name:STUARD, DANA LEIGH
Entity Type:Individual
Prefix:
First Name:DANA
Middle Name:LEIGH
Last Name:STUARD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:221 MORRIS ST
Mailing Address - Street 2:
Mailing Address - City:SCHOFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:54476-1137
Mailing Address - Country:US
Mailing Address - Phone:715-297-0475
Mailing Address - Fax:
Practice Address - Street 1:425 PINE RIDGE BLVD STE 300
Practice Address - Street 2:
Practice Address - City:WAUSAU
Practice Address - State:WI
Practice Address - Zip Code:54401-4124
Practice Address - Country:US
Practice Address - Phone:715-297-0475
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-22
Last Update Date:2022-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI174486-30363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily